I had my first episode in 9th grade. It was a severe depression with anxiety that came out of nowhere. It was so bad I never went back to high school. I had not been diagnosed yet with bipolar.

In my early 20's to late 30's my life was normal, in hindsight maybe a little hypo manic at times. I never thought about the depression in my teens. I had a great career, Systems/Analyst in the computer field. I was a mom and wife. I supported my husband while he went back to school.

In my late 30's depression reared its head again. I still worked while I saw a psychiatrist and therapist and took Prozac. Still I wasn't diagnosed as bipolar.
Eventually the Prozac pushed me into mania and then cycling. I had my first hospitialization. I could not seem to get myself together enough to do my job and went out on long term disability. The next few years were a nightmare. I still was not diagnosed with bipolar and the treatment and meds I got made me worse.

When I was finally diagnosed correctly with Bipolar 1 and got the right meds, I started to have some fairly long periods of normal mood. I thought I was cured and started to go back to school on several occasions. But the normal mood never lasted long enough to complete a degree. I always fell into either Manis or depression eventually.

I am 56 now and I am in menopause. Going through this change of life has done horrible things with my illness. I cycle much more rapidly and have become intimately entwined in mixed states.

This is my version of Bipolar 1 disorder. When I went to John Hopkins Hospital in Baltimore, MD as an inpatient in November 2011. John Hopkins is number 1 in the US for mood disorders. I was told by the director of the program that I was the worse case of rapid cycling that had ever been seen

So, I think the take away is, Bipolar Disorder can change overtime, caused by many many factors.