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Bipolar Disorder

Manic Depression

Reviewed by Psychology Today Staff

Bipolar disorder, also known as manic depression, is a chronically recurring condition involving moods that swing between the highs of mania and the lows of depression. Depression is by far the most pervasive feature of the illness. The manic phase usually involves a mix of irritability, anger, and depression, with or without euphoria. When euphoria is present, it may manifest as unusual energy and overconfidence, playing out in bouts of overspending or promiscuity, among other behaviors.

The disorder most often starts in young adulthood, but can also occur in children and adolescents. Misdiagnosis is common; the condition is often confused with attention-deficit/hyperactivity disorder, schizophrenia, or borderline personality disorder. Biological factors probably create vulnerability to the disorder within certain individuals, and experiences such as sleep deprivation can kick off manic episodes.

There are two primary types of bipolar disorder: Bipolar I and Bipolar II. A major depressive episode may or may not accompany bipolar I, but does accompany bipolar II. People with bipolar I have had at least one manic episode, which may be very severe and require hospital care. People with bipolar II normally have a major depressive episode that lasts at least two weeks along with hypomania, a mania that is mild to moderate and does not normally require hospital care.

Contents

Signs of Bipolar Disorder

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The defining feature of bipolar disorder is mania. It can be the triggering episode of the disorder, followed by a depressive episode, or it can first manifest after years of depressive episodes. The switch between mania and depression can be abrupt, and moods can oscillate rapidly. But while an episode of mania is what distinguishes bipolar disorder from depression, a person may spend far more time in a depressed state than in a manic or hypomanic one.

Hypomania can be deceptive; it is often experienced as a surge in energy that can feel good and even enhance productivity and creativity. As a result, a person experiencing it may deny that anything is wrong. There is great variability in manic symptoms, but features may include increased energy, activity, and restlessness; euphoric mood and extreme optimism; extreme irritability; racing thoughts, unusually fast speech, or thoughts that jump from one idea to another; distractibility and lack of concentration; decreased need for sleep; an unrealistic belief in one's abilities and ideas; poor judgment; reckless behavior including spending sprees and dangerous driving, or risky and increased sexual drive; provocative, intrusive, or aggressive behavior; and denial that anything is wrong.

The duration of elevated moods and the frequency with which they alternate with depressive moods can vary enormously from person to person. Frequent fluctuation, known as rapid cycling, is not uncommon and is defined as at least four episodes per year.

Just as there is considerable variability in manic symptoms, there is great variability in the degree and duration of depressive symptoms in bipolar disorder. Features generally include lasting sad, anxious, or empty mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; a loss of interest or pleasure in activities once enjoyed, including sex; decreased energy and feelings of fatigue or of being "slowed down"; difficulty concentrating, remembering, or making decisions; restlessness or irritability; oversleeping or an inability to sleep or stay asleep; change in appetite and/or unintended weight loss or gain; chronic pain or other persistent physical symptoms not accounted for by illness or injury; and thoughts of death or suicide, or suicide attempts.

The symptoms of mania and depression often occur together in "mixed" episodes. Symptoms of a mixed state can include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. At these times, a person can feel sad yet highly energized.

How common is bipolar disorder?

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About 2.8 percent of American adults have had bipolar disorder in the past year, according to the N

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