Bipolar disorders

About the Condition

Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year or as often as several times a week.

Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary from person to person. Bipolar I and bipolar II disorders also have additional specific features that can be added to the diagnosis based on your particular signs and symptoms.

Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

  • Bipolar I disorder.You’ve had at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).
  • Bipolar II disorder.You’ve had at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days, but you’ve never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.
  • Cyclothymic disorder.You’ve had at least two years — or one year in children and teenagers — of numerous periods of hypomania symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.
  • Other types.These include, for example, bipolar and related disorder due to another medical condition, such as Cushing’s disease, multiple sclerosis or stroke. Another type is called substance and medication-induced bipolar and related disorder..

Criteria for a manic or hypomanic episode

The DSM-5 has specific criteria for the diagnosis of manic and hypomanic episodes:

  • A manic episodeis a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). The episode includes persistently increased goal-directed activity or energy.
  • A hypomanic episodeis a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least four consecutive days.

For both a manic and a hypomanic episode, during the period of disturbed mood and increased energy, three or more of the following symptoms (four if the mood is only irritable) must be present and represent a noticeable change from your usual behavior:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (for example, you feel rested after only three hours of sleep)
  • Unusual talkativeness
  • Racing thoughts
  • Distractibility
  • Increased goal-directed activity (either socially, at work or school, or sexually) or agitation
  • Doing things that are unusual and that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments

To be considered a manic episode:

  • The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in social activities or relationships; or to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
  • Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

To be considered a hypomanic episode:

  • The episode is a distinct change in mood and functioning that is not characteristic of you when the symptoms are not present, and enough of a change that other people notice.
  • The episode isn’t severe enough to cause significant difficulty at work, at school or in social activities or relationships, and it doesn’t require hospitalization or trigger a break from reality.
  • Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

Questions and Answers

Bipolar

What are the early warning signs of a new mood episode?

Early signs of a mood episode differ from person to person and are different for mood elevations and depressions. The better you are at spotting your own early warning signs, the faster you can get help to prevent a full-blown episode. Each person gets to know certain inner feelings that indicate when a mood change is developing. Slight changes in mood, sleep, energy,
self-esteem, sexual interest, concentration, willingness to take on new projects, thoughts of death (or sudden optimism), and even changes in dress and grooming, may be early warnings of an impending highs or lows. Pay special attention to a marked change in your sleep pattern, since this is a common clue that trouble is brewing. Since loss of insight may be an early sign of an impending mood episode, don’t hesitate to ask your family to watch for early warnings that you may be missing.