Understanding Bipolar Disorder

What is bipolar disorder?

Bipolar disorder—also known as manic depression or manic-depressive illness—involves dramatic shifts in mood from the highs of mania to the lows of major depression. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months.

Unlike ordinary mood swings, bipolar disorder is much more intense and disruptive to everyday functioning, affecting energy, activity levels, judgment, and behavior.
During a manic episode, a person might impulsively quit a job, charge up huge amounts of debt, or feel rested after sleeping two hours.

During a depressive episode, the same person might be too tired to get out of bed and full of self-loathing and hopelessness over his or her unemployment status and credit card bills.

Bipolar disorder is more common than many think affecting nearly 3 out of every 100 adults in the U.S according to the National Institutes of Mental Health. Its causes aren’t completely understood, but bipolar disorder often runs in families.

The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood.

Signs and symptoms of bipolar disorder

Bipolar disorder involves periods of elevated mood, or mania. Usually—but not always­—the disorder also involves periods of depression. In a typical case, a person with bipolar disorder cycles between these two extremes—experiencing recurrent episodes of both elevated and depressed mood, often with symptom-free stretches in between.

There are four types of mood episodes that can occur in bipolar disorder, each with a unique pattern of symptoms:

• Mania
• Hypomania
• Depression
• Mixed episode
  

Signs and symptoms of mania

In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. They may also feel like they’re all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. People often behave recklessly during a manic episode­—gambling away savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. They may also become angry, irritable, and aggressive, picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior.

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)

Signs and symptoms of hypomania

Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but their symptoms are milder than those of mania and much less disruptive. Unlike manics, people with hypomania never suffer from delusions and hallucinations. They are able to carry on with their day-to-day lives. To others, it may seem as if the hypomanic individual is merely in an unusually good mood. But unfortunately, hypomania often escalates to full-blown mania or is followed by a major depressive episode.

Signs and symptoms of bipolar depression

The depressive phase of bipolar disorder is very similar to that of major depression. However, there are some notable differences. When compared to major depression, bipolar depression is more likely to include symptoms of low energy. People with bipolar depression tend to move and speak slowly and sleep a lot. They are also more likely to have psychotic depression, a condition in which they’ve lost contact with reality.

Common symptoms of bipolar depression include:

• Feeling hopeless, sad, or empty.
• Loss of interest in things you used to enjoy
• Fatigue or loss of energy
• Physical and mental sluggishness
• Appetite or weight changes
• Sleeping too much or too little
• Concentration and memory problems
• Feelings of self-loathing, shame, or guilt
• Thoughts of death or suicide

Signs and symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania and depression. Common signs of a mixed episode include agitation, irritability, insomnia, appetite changes, loss of contact with reality, and suicidal thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Types of bipolar disorder

The course of bipolar disorder varies widely from person to person, with unpredictable differences in the pattern and frequency of the manic and depressive episodes. 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. The duration and severity of each episode also differs.

Each of the four types of bipolar disorder have a unique pattern of symptoms:

• Bipolar I Disorder – Mania and depression 
  Bipolar I Disorder is the classic manic-depressive form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. Although a previous episode of major depression is not required for diagnosis, the vast majority of people with Bipolar I Disorder have experienced one. The typical course of Bipolar I Disorder involves recurring cycles between mania and depression.
• Bipolar II Disorder – Hypomania and depression 
  In Bipolar II disorder, the person doesn’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression. In order to be diagnosed with Bipolar II Disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime. If you ever have a manic episode, your diagnosis would be changed to Bipolar I Disorder.
• Cyclothymia – Hypomania and mild depression 
  Cyclothymia, also known as cyclothymic disorder, is a milder form of bipolar disorder. Like bipolar disorder, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be monitored and treated.
• Rapid Cycling – Frequent episodes of mania, hypomania, or depression 
  Rapid cycling is a subtype of bipolar disorder characterized by four or more episodes of mania, hypomania, or depression within one year. The shifts from low to high can occur over a matter of days or hours. Rapid cycling can occur within any type of bipolar disorder. It usually develops later in the course of bipolar disorder, but it is sometimes just a temporary condition.

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 a high number of depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.

The warning signs of suicide include:

• Talking about death, self-harm, or suicide
• Feeling hopeless or helpless
• Feeling worthless or like a burden to others
• Putting affairs in order or saying goodbye
• Acting recklessly, as if one has a “death wish”
• Seeking out weapons or pills that could be used to commit suicide

If you or someone you know is having suicidal thoughts, seek help immediately. You can call a doctor, a suicide hotline, or your local hospital. If you believe that a suicide attempt is imminent, call 911 immediately and stay with the person until help arrives.

Triggers and risk factors for bipolar disorder

Research indicates that some people are genetically predisposed to bipolar disorder. But not everyone with an inherited vulnerability develops the illness, indicating that external factors also play a role. These external risk factors are called triggers. Triggers can set off a bipolar disorder or prolong an existing mood episode. Many episode of mania or depression occur, however, without an obvious trigger.

• Stress - Severe stress or emotional trauma can trigger either depression or mania in someone with a genetic vulnerability to bipolar disorder. Stress can also worsen a bipolar mood episode or extend its duration.
• Major Life Event - Major life events both good and bad can trigger an episode of bipolar disorder. These events tend to involve drastic or sudden changes, such as getting married, going away to college, starting a new job, or retiring.
• Substance Abuse - While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and 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 may induce 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.

Seeking help for bipolar disorder

Living with untreated bipolar disorder can cause problems in everything from your career to your relationships to your outlook on life. Diagnosing the problem as early as possible and starting a comprehensive treatment plan can help prevent these complications. 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, it is essential to fully understand the condition and its challenges. Read more to learn how to keep your symptoms under control with therapy, medication, and a healthy recovery lifestyle.

Related links for bipolar disorder signs and symptoms

General information about bipolar disorder

Bipolar Disorder - Article on the signs, symptoms, causes, and treatment of bipolar disorder, or manic depression. (National Institute of Mental Health)

Understanding Bipolar Disorder: What You Need To Know About This Medical Illness (PDF) – Learn how to recognize bipolar disorder, what episodes of mania and depression feel like, and how to cope with the disorder. (National Alliance on Mental Illness)

Bipolar Disorder: Rapid Cycling and its Treatment – Includes information on the signs, symptoms, and causes of rapid cycling in bipolar disorder. (Depression and Bipolar Support Alliance)

What Causes Bipolar Disorder? (PDF) – Describes how an interaction between genetic vulnerability, biological vulnerability, and life stress causes bipolar disorder. (Centre for Clinical Interventions)

Signs and symptoms of bipolar disorder

Bipolar I Disorder – Covers the symptoms and diagnostic criteria for Bipolar I Disorder, including the signs of individual mood episodes of hypomania, mania, and depression. (Internet Mental Health)

Bipolar II Disorder – Diagnostic overview of Bipolar II Disorder covers the signs, symptoms, as well as the criteria for a hypomanic or depressive mood episode. (Internet Mental Health)

Bipolar disorder in children and teens

About Pediatric Bipolar Disorder – Guide to the specific signs and symptoms of bipolar disorder in children and adolescents. Includes information on diagnosis and treatment. (Child and Adolescent Bipolar Foundation)

The Bipolar Child – Find answers to common questions about manic depression in children, sign up for the newsletter, and learn about the latest bipolar disorder research. (The Bipolar Child)

Young and Bipolar – Magazine article discusses bipolar disorder in children and teens, signs of manic and depression, and why the disease is striking earlier. (Time Magazine)

TeensHealth: Bipolar Disorder – Article for teens discusses the signs, symptoms, causes, and treatment of bipolar disorder, or manic depression. (Nemours Foundation)

The Storm in My Brain: Kids and Mood Disorders – This introduction to mood disorders includes drawings by children suffering from bipolar disorder and tips for parents. (Depression and Bipolar Support Alliance)

Bipolar Disorder and suicide prevention

National Suicide Prevention Lifeline - Suicide prevention telephone hotline funded by the U.S. government. Provides free, 24-hour assistance. 1-800-273-TALK (8255).

Understanding Suicidal Thinking – Learn how to fight suicidal thoughts, help someone else who is suicidal, and respond to an emergency situation. (Depression and Bipolar Support Alliance)

Delving deeper into bipolar disorder

Manic-Depressive Illness – Online booklet about bipolar disorder, or manic depression, covers the signs, symptoms, causes, and treatment options. (Internet Mental Health)

Melinda Smith, M.A., Jeanne Segal, Ph.D., and Robert Segal, M.A., contributed to this article. Original artwork by Dick Hutman. Last modified on: 2/08/08.