You can experience visual and auditory hallucinations with bipolar disorder. They can occur during mania or depressive episodes. Treatment and avoiding triggers may help.

Bipolar disorder is a mental health condition defined by “high” and “low” mood states that include episodes of mania, hypomania, or depression.

How you experience these mood episodes can depend on different factors. Episodes might vary in length and severity, and you could even notice changes in mood symptoms over time.

Yet many people don’t realize one important fact about mood episodes: They can also involve hallucinations.

Hallucinations tend to happen more frequently with the manic episodes that characterize bipolar I, though they can also appear during depressive episodes.

Hallucinations also separate hypomania from mania. If you hallucinate during what otherwise feels like hypomania, the episode automatically meets criteria for mania, notes the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Hallucinations do often happen as a symptom of psychosis or a disconnect from reality. Other main symptoms of psychosis include:

  • delusions
  • self-isolation or withdrawal
  • disorganized speech and thoughts
  • feelings of suspiciousness and confusion

Psychosis is a symptom, not a mental health condition in and of itself, and it’s somewhat common with bipolar disorder.

Two different types of psychosis can happen with bipolar disorder:

  • Mood congruent psychosis: The symptoms you experience align with the mood episode. You might hear people laughing and talking or cheering you on during an episode of mania, for example. This type is more common.
  • Mood incongruent psychosis: These symptoms conflict with your mood state. In a state of depression, for example, you might believe you’re someone famous or hear a voice telling you that you’re invincible.

In a 2022 study of 162 people with bipolar disorder, 59% of participants reported experiencing symptoms of psychosis in their lifetime.

Almost 45% of those who experience psychosis symptoms experienced at least one instance of mood-incongruent symptoms, which are more likely to include hallucinations.

Although some people living with bipolar disorder do experience psychosis, it’s possible to hallucinate with bipolar disorder without ever having any other symptoms of psychosis.

Hallucinations can involve any of your senses, though usually just one at a time.

Types of hallucinations include:

  • Auditory: hearing things no one else can hear
  • Somatic: feeling something you can’t see or hear
  • Visual: seeing something no one else can see

Hallucinations are often brief. You might see flashing lights, feel someone touch your hand, or hear music playing.

They can also be longer and more detailed. You might hear voices having a conversation or see a long-departed loved one walking past your house.

Experts don’t fully understand why some people with bipolar disorder experience hallucinations, and others don’t.

They do know hallucinations can happen for plenty of different reasons, including chronic medical conditions, head injuries, and seizures, just to name a few.

As for hallucinations that happen with bipolar disorder? Well, potential causes can still vary pretty widely. A few recognized triggers include:

Stress

Any kind of stress can have an effect on mental and physical well-being. This includes both ordinary life stress and the added strain that can happen as a result of living with a mental health condition.

Common sources of stress include:

You might be more likely to hallucinate when under a lot of daily stress or feeling overwhelmed and anxious about something in particular.

In some cases, stress can also serve as a trigger for mood episodes.

Lack of sleep

During manic episodes, you might feel as if you need less sleep.

Sleep deprivation is a key cause of hallucinations. Regularly getting fewer than 6 or 7 hours of sleep each night could increase your chances of hallucinating and make some mood symptoms worse.

Not getting enough rest can also prompt manic episodes and contribute to anxiety, depression, and other health concerns. Most adults need between 7 and 9 hours of sleep each night for optimal health.

Medication side effects

Hallucinations may happen as a side effect of certain medications used to treat bipolar disorder, such as antidepressants like bupropion or selective serotonin reuptake inhibitors (SSRIs).

If you hallucinate while taking antidepressants or any other medication that lists hallucinations as a potential side effect, let your prescriber know right away. They can help you monitor your symptoms and switch your medication or adjust the dose if needed.

Alcohol and other substances

Hallucinations can happen as a result of:

Some people also experience hallucinations, along with paranoia and other symptoms of psychosis, when using cannabis.

It’s not uncommon to use alcohol and substances to cope with emotional turmoil and distress, especially when living with a lifelong condition like bipolar disorder. Mood episodes can feel overwhelming, even unbearable, and it’s not always easy to manage them without wanting to numb that pain.

Keep in mind, though, that these substances only provide temporary relief and may even worsen mental health symptoms. Working with a therapist can help you explore more long-lasting methods of relief.

Postpartum psychosis

Some people experience hallucinations and other symptoms of psychosis after childbirth.

Postpartum psychosis is rare, but it’s more common in people with a history of bipolar disorder — and it always represents a medical emergency.

Connect with your care team right away if you’ve recently given birth and experience hallucinations, along with:

  • a general sense of confusion or disorientation
  • sudden shifts in mood
  • thoughts of violence or self-harm
  • fears that you or someone else wants to hurt your baby

It’s always safest to let your doctor know about hallucinations after childbirth, even if you don’t notice other signs of psychosis. They can help you watch for other symptoms and offer support with getting the right treatment.

Other potential causes

Medical causes of hallucinations include:

It’s also possible to hallucinate:

  • during periods of isolation
  • as part of a spiritual or religious experience

Your symptoms could meet the criteria for bipolar disorder with psychotic features, but they could better fit a diagnosis of schizoaffective disorder.

This mental health condition involves mixed symptoms of bipolar disorder and schizophrenia. But with schizoaffective disorder, you’ll also experience psychosis when you aren’t having a mood episode.

To diagnose this condition, a mental health professional will help you track when psychosis appears and note whether it’s present during just your mood episodes or at other times, too.

Since hallucinations can happen for so many reasons, it may take some time to narrow down what’s causing them or confirm whether they’re related to bipolar disorder.

Start by talking with a therapist or other mental health professional. When telling them about your hallucinations, also be sure to mention how you felt beforehand and any other symptoms you noticed. This added information can make it easier for them to arrive at the right diagnosis.

For example, maybe you only notice hallucinations when you haven’t slept well for several days or when your mood is very low. If you also report head pain or other physical symptoms, your therapist may encourage you to connect with a healthcare professional to rule out underlying health conditions.

Keep in mind it’s entirely possible to have more than one mental health condition at the same time. Anxiety, for example, commonly occurs with bipolar disorder — and some people living with anxiety do report hearing voices.

Typically, bipolar disorder requires professional treatment, though treatment may require different approaches:

  • during mood episodes
  • once mood symptoms start to improve
  • when you aren’t experiencing any symptoms

During a mood episode, treatment generally focuses on improving severe symptoms with medications, including:

After a mood episode, treatment generally aims to reduce future mood episodes and help you maintain a euthymic (symptom-free) mood state.

To achieve this, you might work with your treatment team to:

  • find medication dosages that work well, with few side effects
  • learn helpful ways to manage stress
  • address hallucinations and any other concerning symptoms in therapy
  • explore lifestyle changes and self-care habits to improve sleep, physical health, and emotional well-being
  • discuss complementary treatments, like light therapy, acupuncture, or mindfulness practices like meditation and yoga

These strategies can go a long way toward improving all symptoms of bipolar disorder — including hallucinations that happen with psychosis and those that relate to sleep loss or stress.

If you live with bipolar disorder, it’s always a good idea to work with a therapist who has experience treating the condition. Therapists trained to recognize the often complex presentation of mood episodes can identify the correct diagnosis and help you find the most effective treatment.

When treatment doesn’t seem to help

Talk with your prescriber if your current medications don’t seem to be working or are causing uncomfortable side effects. It’s best to keep taking the medication unless they tell you otherwise. Abruptly stopping a medication can lead to serious side effects.

It’s also important to continue taking any prescribed medications, even when you have no mood symptoms at all. Stopping the medication could trigger a mood episode.

Concerned about side effects? Ask your care team about reducing your dose or trying another medication.

Mood episodes remain the defining feature of bipolar disorder, but the condition can involve hallucinations, too.

Sure, they might feel less frightening when you recognize them as hallucinations and never lose touch with reality. But it’s entirely natural to feel unsettled, confused, or even stressed, which could make bipolar symptoms worse.

A therapist can offer more insight into potential causes and help you take steps to find the most effective treatment.