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Bipolar Disorder, Depression and Psychosis

Bipolar disorder is associated with extremely high (mania/hypomania) and low (depressed) moods. This is typically seen with emotional changes, behavioral changes, energy changes and so on.

Psychosis, on the other hand is the presence of delusions and hallucinations. Delusions – false beliefs that persist in spite of the existence of contrary evidence – and hallucinations are most closely associated with schizophrenia.

However, symptoms of psychosis can occur in bipolar disorder and depression as well.

Mania / Hypomania and Psychosis

Psychosis is not a diagnostic criterion for mania but is known to occur alongside mania for many people. Approximately three-quarters of people with mania suffer from delusions. Delusions of grandeur (thinking you are a deity), paranoia and other forms of psychosis – or losing touch with reality – are common.

Psychosis is not present in hypomania.

People experiencing a mixed mood in bipolar disorder can also experience psychosis that may be consistent with mania or depression.

Depression and Psychosis

Psychosis can also occur during the depressed phase of bipolar disorder or during unipolar depression. Psychotic depression, in fact, is one of the most severe forms of depression. With psychotic depression a person experiences hallucinations or delusions that may or may not be consistent with mood.

If the psychosis is consistent with mood the person may unreasonably feel:

  • They have sinned and are unreasonably guilty and remorseful
  • They are worthless and should live with complete deprivation and degradation

If the psychosis is inconsistent with depression the person may unreasonably feel:

  • Paranoid
  • Persecuted

The Problem with Psychosis

Sure, when described in medical-eze it doesn’t sound so bad – who wouldn’t want to feel like queen for a day? The trouble is people with psychosis truly believe their delusions and hallucinations; that is what makes them so dangerous. The trouble is not in believing that you are Jesus, the trouble is what you would do because of that belief.

As one woman explained to me, she thought she could communicate with nature and so closed her eyes while speeding down the freeway, expecting the wind to tell her when to turn her car. (The woman, miraculously, was OK.) Even after she crashed, she was not convinced that she was psychotic.

What to Do if You See Psychosis

I say what to do if you “see” psychosis rather than if you “experience” psychosis as it’s very likely if you’re the one experiencing it, you won’t realize it.

If you see psychosis in someone it is not something to laugh about or shake off. In fact, one of the problems many people have is that others indulge their psychosis, making them think it is all the more real. Anyone with psychosis needs help immediately, even if they don’t know it.


  • Remain calm and try to facilitate a calm environment, speak slowly and quietly, give step-by-step instructions
  • Try to connect with the emotion behind the delusion
  • Show compassion – this is an illness and not something the person is doing on purpose
  • Consider your and the person’s safety
  • Contact their doctor immediately


  • Argue with the delusion / hallucination – this can create major agitation

The important thing to remember is that psychosis is a real problem and consists of a persistent belief that is difficult to change, so don’t try. Just focus on safety and getting help for the person experiencing psychosis.

Please see this excellent guide on dealing with psychosis by the British Columbia Schizophrenia Society for more information.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

11 thoughts on “Bipolar Disorder, Depression and Psychosis”

  1. Doing better now after the episode but i would like to tell my story. Ive done some research so i have a pretty good understanding of what happened. It started off as a pretty bad social anxiety depression that started at 15. That lasted all throughout high school. When I was 16 I met a girl and developed some pretty strong feelings toward her. One day she moved away without telling me a word. We wouldnt speak again for 4 years. My senior year of high school i took psychology and really excelled at it. It made me really start to think about life in a relatively new way. It made me realize that i was basically in charge of my thought and feelings. The depression went away, but not the shyness of the social anxiety. I graduated high school in 2011. In January of 2013 a close friend of mine shot and killed himself. I was devasted. But we had a mutual friend in the girl i knew four years ago. We started talking and then her grandpa, who i also knew, passed away. She was a wreck after losing one of her best friends and then her grandpa, and i was there for her. We started having some really deep and meaningful conversations and then eventually one night i had what i consider to be a spiritual awakening. I had all these deep insights and ideas about changing the world and pushing people towards a higher level of enlightenment and consciousness. My mindset was this: when i was going through social anxiety my thought was always a ghandi quote to help push myself through the day. Be the change you want to see in the world. When I had this “awakening” I realized that for me to make that transition I hadto be iinspired to be motivated to have the ambition to change so it made sense to me that to change the world you had to apply the same concept so I went to Facebook and started posting all these thoughts and ideas. Thinking I was going to spark the revolution. Well one night when I was doing this I got a phone call from 777 777 7777 and this person told me that they were God and I was the chosen one and some other things. I found out later that it was a friend playing a jokeon me, which was my innicial reaction. A couple days later, April 1st, I started having some real delutions about being the reincarnation of Jesus and it definitely didnt help that it was so close to Easter. So this went on until April 4th, when I had my break and it wasnt pretty. I started saying some really crazy things and life seemed like it was a movie and everything was a test from God. All that seems crazy to me now, but at the time it seemed very real. I mean it was real, at least to me. So all day I was looking for whatever it was I was supposed to do. On top of i I had been smoking A LOT of weed. It was about 630 in the evening and my dad brought me to get cigarettes. So I decided on my head that whatever I was supposed to do was at the gas station. When I got there I saw a green jetta that somebody had just purchased with a dealership paper on the back that said merry joseph kress. So I stole the car but it gets worse. I proceeded to purposely crash it into the back of a police car. To shorten the last part up I spent six months in a mental ward three on recidential care and 6 in a halfway house for the crimes. Ive been home since June and havent had any signs of a breakdown since. No meds either. Life is good and things can only get better. No more delusions or anything. Its amazing what kinds of things our brains can come up with.

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