What is Bipolar Disorder?

Bipolar disorder (also known as manic depression) is a treatable illness marked by extreme changes in mood, thought, energy and behavior. It is not a character flaw or a sign of personal weakness. Bipolar disorder is also known as manic depression because a person's mood can alternate between the "poles" of mania (highs) and depression (lows). These changes in mood, or "mood swings," can last for hours, days, weeks or months.

Nearly six (6) million adult Americans are affected by bipolar disorder. It usually begins in late adolescence (often appearing as depression during the teen years), although it can start in early childhood or later in life. An equal number of men and women develop this illness (men tend to begin with a manic episode, women with a depressive episode), and it is found among all ages, races, ethnic groups, and social classes. The illness tends to run in families and appears to have a genetic link. Like depression and other serious illnesses, bipolar disorder can also negatively affect spouses and partners, family members, friends, and coworkers.

Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase of the illness are similar. Most people who have bipolar disorder talk about experiencing "highs" and "lows"—periods of mania and depression. These swings can be severe, ranging from extreme energy to deep despair. The severity of the mood swings and the way they disrupt normal life activities distinguish bipolar mood episodes from ordinary mood changes.

When people experience symptoms of both a manic and a depressive episode at the same time, they're said to be experiencing a mixed state (or mixed mania). They have all of the negative feelings that come with depression, but they also feel agitated, restless and activated, or "wired." Those who have had a mixed state often describe it as the very worst part of bipolar disorder.

 

Symptoms of Mania: The "Highs" of Bipolar Disorder

  • Heightened mood, exaggerated optimism and self-confidence

  • Excessive irritability, aggressive behavior

  • Decreased need for sleep without experiencing fatigue

  • Grandiose thoughts, inflated sense of self-importance

  • Racing speech, racing thoughts, flight of ideas

  • Impulsiveness, poor judgment, easily distracted

  • Reckless behavior

  • In the most severe cases, delusions and hallucinations

 

Symptoms of Depression: The "Lows" of Bipolar Disorder

  • Prolonged sadness or unexplained crying spells

  • Significant changes in appetite and sleep patterns

  • Irritability, anger, worry, agitation, anxiety

  • Pessimism, indifference

  • Loss of energy, persistent lethargy

  • Feelings of guilt, worthlessness

  • Inability to concentrate, indecisiveness

  • Inability to take pleasure in former interests, social withdrawal

  • Unexplained aches and pains

  • Recurring thoughts of death or suicide

Bipolar Depression

As you can see from the list above, the symptoms of bipolar disorder's "low" period are very similar to those of unipolar depression. That's why the "lows" of this illness are sometimes referred to as "bipolar depression." These lows are one thing that most mood disorders have in common.

People with bipolar disorder experience bipolar depression (the lows) more often than mania or hypomania (the highs). Bipolar depression is also more likely to be accompanied by disability and suicidal thinking and behavior.

It's during periods of bipolar depression that most people get professional help and receive a diagnosis. In fact, most people with bipolar disorder in the outpatient setting are initially seen for—and diagnosed with—unipolar depression.

Studies show that, in the primary care setting alone, 10-25 percent of those diagnosed with unipolar depression may actually have bipolar disorder. And the percentage is even higher in the psychiatric setting. And incorrect treatment for bipolar disorder can actually lead to episodes of mania and other problems. 

Types of Bipolar Disorder

Patterns and severity of symptoms (or episodes of "highs" and "lows") determine different types of bipolar disorder. The two most common types are bipolar I disorder and bipolar II disorder. 

Treatments

Treatment of bipolar disorder may include support groups, medication, talk therapy, or other strategies that you and your health care provider may want to try. The right treatment is the one that works best for you. 

Bipolar Disorder across the Lifespan

Bipolar disorder can affect anyone, including children, adolescents, adults, and the elderly. 

There are several kinds of bipolar disorder. Each kind is defined by the length, frequency and pattern of episodes of mania and depression.

BIPOLAR I DISORDER

Bipolar I is characterized by one or more manic episodes or mixed episodes (which is when you experience symptoms of both a mania and a depression). Typically a person will experience periods of depression as well. Bipolar I disorder is marked by extreme manic episodes.

BIPOLAR II DISORDER

Bipolar II disorder is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes.

The highs in bipolar II, called hypomanias, are not as high as those in bipolar I (manias). Bipolar II disorder is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported. If you have recurring depressions that go away periodically and then return, ask yourself if you have also:

  • Had periods (lasting four or more days) when your mood was especially or abnormally energetic or irritable?

  • Were you:

    • Feeling abnormally self-confident or social?

    • Needing less sleep or more energetic?

    • Unusually talkative or hyper?

    • Irritable or quick to anger?

    • Thinking faster than usual?

    • More easily distracted/having trouble concentrating?

    • More goal-directed or productive at work, school or home?

    • More involved in pleasurable activities, such as spending or sex?

  • Did you feel or did others say that you were doing or saying things that were unusual, abnormal or not like your usual self?

If so, talk to your health care provider about these energetic episodes, and find out if they might be hypomania. Getting a correct diagnosis of bipolar II disorder can help you find treatment that may also help lift your depression.

NOT OTHERWISE SPECIFIED (NOS)

Bipolar disorder that does not follow a particular pattern (for example, re-occuring hypomanic episodes without depressive symptoms, or very rapid swings between some symptoms of mania and some symptoms of depression) is called bipolar disorder Not Otherwise Specified (NOS).

CYCLOTHYMIA

Cyclothymia is a milder form of bipolar disorder characterized by several hypomanic episodes and less severe episodes of depression that alternate for at least two years. The severity of this illness may change over time.

RAPID CYCLING

Bipolar disorder with rapid cycling is diagnosed when a person experiences four or more manic, hypomanic, or depressive episodes in any 12-month period. Rapid cycling can occur with any type of bipolar disorder, and may be a temporary condition for some people.

DIAGNOSIS

DBSA has found that nearly 7 of every 10 people with bipolar disorder are misdiagnosed at least once, and that the average length of time from a person's first bipolar symptoms to correct diagnosis and treatment is 10 years. One of the reasons for this is that many people don't report all of their symptoms. It is important for people to share all symptoms, even those not present during a health care appointment, as well as their family history to help health care providers make a correct diagnosis.

Sometimes symptoms of hypomania (a milder form of mania) are mistaken for "a really good day." Many people don't report symptoms of mania or hypomania because they feel good and it often doesn't feel like an illness.

WHAT IS THE DIFFERENCE BETWEEN BIPOLAR DISORDER AND ORDINARY MOOD SWINGS?

The three main things that make bipolar disorder different from ordinary mood swings are:

  • Intensity: Mood swings that come with bipolar disorder are usually more severe than ordinary mood swings.

  • Length: A bad mood is usually gone in a few days but mania or depression can last weeks or months. With rapid cycling, moods last a short time but change quickly from one extreme to another. With rapid cycling, "level" (euthymic) moods do not last long.

  • Interference with life: The extremes in mood that come with bipolar disorder can severely disrupt your life. For example, depression can make a person unable to get out of bed or go to work or mania can cause a person to go for days without sleep.

For more detailed information on the types of bipolar disorder and their symptoms, read the Mood Disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which may be available at your local library.