Do you have bipolar disorder? Is it bipolar I or bipolar II? Here’s how to recognize the signs and symptoms of manic depression, including mania, hypomania, bipolar depression, and cyclothymia.
What is bipolar disorder?
We all have our ups and downs, but with bipolar disorder (once known as manic depression or manic-depressive disorder) these peaks and valleys are more severe. Bipolar disorder causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they can interfere with your job or school performance, damage your relationships, and disrupt your ability to function in daily life.
During a manic episode, you might impulsively quit your job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.
The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting in unnecessary suffering.
Since bipolar disorder tends to worsen without treatment, it’s important to learn what the signs and symptoms look like. Recognizing the problem is the first step to feeling better and getting your life back on track.
Myths and facts about bipolar disorder
Myth:
People with bipolar disorder can’t get better or lead a normal life.
Fact:
Many people with bipolar disorder have successful careers, happy family lives, and satisfying relationships. Living with bipolar disorder is challenging, but with treatment, healthy coping skills, and a solid support system, you can live fully while managing your symptoms.
Myth:
People with bipolar disorder swing back and forth between mania and depression.
Fact:
Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms.
Myth:
Bipolar disorder only affects mood.
Fact:
Bipolar disorder also affects your energy level, judgment, memory, concentration, appetite, sleep patterns, sex drive, and self-esteem. Additionally, bipolar disorder has been linked to anxiety, substance abuse, and health problems such as diabetes, heart disease, migraines, and high blood pressure.
Myth:
Aside from taking medication, there is nothing you can do to control bipolar disorder.
Fact:
While medication is the foundation of bipolar disorder treatment, therapy and self-help strategies also play important roles. You can help control your symptoms by exercising regularly, getting enough sleep, eating right, monitoring your moods, keeping stress to a minimum, and surrounding yourself with supportive people.
Bipolar disorder can look very different in different people. The symptoms can vary widely in their pattern, severity, and frequency. 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.
There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.
Mania symptoms
In the manic phase of bipolar disorder, it’s common to experience feelings of heightened energy, creativity, and euphoria. If you’re experiencing a manic episode, you may talk a mile a minute, sleep very little, and be hyperactive. You may also feel like you’re all-powerful, invincible, or destined for greatness.
But while mania feels good at first, it has a tendency to spiral out of control. You may behave recklessly during a manic episode: gambling away your savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. You may also become angry, irritable, and aggressive—picking fights, lashing out when others don’t go along with your plans, and blaming anyone who criticizes your behavior. Some people even become delusional or start hearing voices.
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).
Hypomania symptoms
Hypomania is a less severe form of mania. In a hypomanic state, you’ll likely feel euphoric, energetic, and productive, but will still be able to carry on with your day-to-day life without losing touch with reality. To others, it may seem as if you’re merely in an unusually good mood. However, hypomania can result in bad decisions that harm your relationships, career, and reputation. In addition, hypomania often escalates to full-blown mania or is followed by a major depressive episode.
Bipolar depression symptoms
In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments.
Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse—triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.
Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. With bipolar depression, you may move and speak slowly, sleep a lot, and gain weight. In addition, you’re more likely to develop psychotic depression—a condition in which you lose contact with reality—and to experience major problems in work and social functioning.
Common symptoms of bipolar depression include:
- Feeling hopeless, sad, or empty.
- Irritability.
- Inability to experience pleasure.
- Fatigue or loss of energy.
- Physical and mental sluggishness.
- Appetite or weight changes.
- Sleep problems.
- Concentration and memory problems.
- Feelings of worthlessness or guilt.
- Thoughts of death or suicide.
Symptoms of a mixed episode
A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.
Types of bipolar disorder
Since symptoms can vary so much from person to person, bipolar disorder is often broken down into different types, identified by the pattern of mania and depression.
Bipolar I Disorder (mania or a mixed episode)
This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.
Bipolar II Disorder (hypomania and depression)
In Bipolar II disorder, you don’t experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.
Cyclothymia (hypomania and mild depression)
Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.
Unspecified or other types
If you experience symptoms that do not fit into another category, or they stem from another medical condition, such as substance abuse, your doctor may diagnose unspecified bipolar disorder.
What is rapid cycling?
Some people with bipolar disorder develop “rapid cycling” where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.
Getting an accurate diagnosis
Getting an accurate diagnosis for bipolar disorder isn’t always easy. The mood swings of bipolar disorder can be difficult to distinguish from other problems such as major depression, ADHD, and borderline personality disorder. For many people with bipolar disorder, it takes time and numerous doctor visits before the problem is correctly identified and treated.
Making the diagnosis of bipolar disorder can be tricky even for trained professionals, so it’s best to see a psychiatrist with experience treating bipolar disorder rather than a family doctor or another type of physician. A psychiatrist specializes in mental health and is more likely to know about the latest research and treatment options.
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