Bipolar mood cycling disorders are often misunderstood.  Why is that?  I suspect it is because mood cycling disorders are like a bouquet of flowers - there are many various presentations and combinations.  

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With so many “bipolar-like” presentations, the medical community is not in full agreement on the terminology.  This isn’t surprising, as medicine is not a black-and-white science.  It is a practice.  Clinical judgment is tailored to the unique presentations of each patient at a particular point in time.  Clinical judgement is also influenced by the practitioner’s and patient’s experiences.  A person with back pain can go to three different providers, at three different points in time, and get three different treatment recommendations. 

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That is why I believe it is so important to educate patients about the various diagnostic and treatment possibilities.  Well educated patients not only provide critical information, but they also become critical members of their own treatment team.  This can make all the difference in the world (see article on Why Do I Need to Know). 

While there are some basic rules of thumb for bipolar presentations, people can present differently.  Thus, I think it is important to discuss this - as many people are under the impression that bipolar is simply the oscillation between a depressed and super happy mood.

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What is Bipolar Disorder? 

Bipolar disorder is a biological brain disorder causing severe fluctuations in mood, energy, thinking and behavior. It was previously known as manic-depression, as it causes moods to shift between mania and depression.  

Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder can be more severe and cause significant disruptions in a person’s life.  Severe changes in energy and behavior go along with the mood shifts. The mood shifts can include severe irritable episodes.  The ups and downs periods of highs and lows are referred to as mania (high) and depression (low).  

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These rollercoaster ups and downs make relationships quite challenging as those around the individual often “walk on egg shells,” never knowing what person they will get.  The patient may or may not be aware of how damaging their moods swings are and often have a history of damaged personal relations and poor job or school performance.  They may have a chaotic past characterized by frequent moves, multiple damaged relationships, substance abuse, and financial hardships.  

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But there is good news -- bipolar disorder can be treated, and people with this illness can lead full and productive lives.  

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Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

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What Are the Symptoms of Bipolar Disorder?

 

Bipolar disorder presents in a roller-coaster fashion.  Some people experience equal periods of mania and depression, while others spend most of their time in the manic phase and others experience a majority of depressive phases.  Again, it is different for different people.

 

The length of these phases vary.  Some people with bipolar disorder experience very short, rapid cyclings between the moods.  Others have a longer weekly or monthly cycle.  Still others may only cycling twice per year - spring and fall for example.   

 

Manic phase

For many people, signs and symptoms in the manic phase may include:

• Distractibility, difficulty with concentration, difficulty staying focused.

• Impulsivity that appears as poor judgement - perhaps spending money they shouldn’t, engaging in hyper-sexual activities, or otherwise making impulsive life decisions.

• Grandiose feelings, euphoria, extreme optimism and inflated self-esteem, being recklessness, or taking chances not normally taken 

• Flight of ideas, rapid speech, racing thoughts, agitation and increased physical activity 

• Increased activity and high energy level.

• Difficulty sleeping 

• Increased talkativeness

 

Depressive phase

In the depressive phase, signs and symptoms include: 

• Persistent feelings of sadness, anxiety, guilt or hopelessness 

• Low energy and motivation. fatigue and loss of interest in daily activities 

• Disturbances in sleep and appetite 

• Chronic pain without a known cause 

• Recurring thoughts of suicide 

 

Both phases can include symptoms of irritability, suicidal ideation, agitation, profound anxiety, and poor concentration.  Always take any thoughts or conversations about suicidal ideations seriously and seek immediate medical or mental attention.

 

What is the Spectrum?

 

It is helpful to think of bipolar mood states occurring on a spectrum.  With one end having minor symptoms and the other end with severe symptoms.

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Those with mild symptoms may only experience minor disruptions to their life.  A mild to moderate level of mania is called hypomania. Hypomania may feel good or “normal,” and the person may experience enhanced functioning and productivity.  This often results in the denial of a roller-coaster presentation.  Rather, the person believes they simply got over one more depressive phase and all is okay.  Even when family and friends recognize the mood swings, it may be difficult to convince the person to seek help.  However, without proper treatment, the disorder can progress and the hypomanic symptoms can become more severe (become severe mania).  Sometimes, the key is recognizing the roller-coaster depression.  Most people don’t complain about hypomania, it is the depressive phases they don’t like.  This is when they seek help and are often prescribed antidepressants for the depression.  Antidepressants may or may not be the right medication.  For some, antidepressants can make things worse (called antidepressant kindling).  

 

Those with severe symptoms may find it difficult to maintain a normal life without treatment. The symptoms of mania or depression may be accompanied with psychotic symptoms.  This include delusions and/or hallucinations.  Delusions are are strongly held (fixed) false beliefs that are not influenced by logic and not within the person’s normal cultural beliefs.  Delusions during manic phases may include beliefs about government conspiracies, ability to hold special powers, or having special communications through the television or radio.  Delusions during depressive phases may include the person falsely believing they have committed a crime or become ruined or penniless.  Hallucinations are sensory sensations that are not actually there; for example, seeing, smelling, or hearing things that others do not.  Hallucinations may occur during either the depressive or manic phases.  People with bipolar disorder may be incorrectly diagnosed with schizophrenia - as the symptoms can initially present in a clinically similar fashion.  

 

In some people, symptoms of mania and depression may occur together. This is called a mixed state.  Symptoms of a mixed state may include agitation, anxiety, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking.  During the mixed state the person feels sad, depressed, and hopeless, while also feeling extremely energized.  This is often not a pleasant sensation.  

 

Substance abuse, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and attention deficit disorder, also may occur in a persons with bipolar disorder.  Some of these disorders may respond to the treatments for bipolar disorder, while other co-occurring disorders may need separate treatment.  

 

Where Can I Get More Information?

 

The internet is full of information about bipolar disorder.  Please make sure you obtain information from a reputable source and run that information by your medical or psychiatric provider.  The following organizations typically provide quality information:

- National Institutes of Health
- WebMD
- Psychology Today
- NAMI
- MayoClinic
- Medline Plus

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What if I Suspect Bipolar Disorder?

 

If it is suspected that you or another person has bipolar disorder, talk to you medical provider or a mental health specialist.  Bipolar can be treated and early diagnosis and treatment is important.