Previously known as manic-depressive disorder, bipolar disorder is another one of our misunderstood diagnoses. The more colloquial understanding of being "manic" or "bipolar," popularized in songs, movies, and how we describe ourselves, has led many to worry that maybe they're suffering from bipolar disorder. However, it's so much more than just rapid mood swings or changes in behavior. Today's blog will help break it down for you.
Bipolar disorder is defined in the DSM V as an episodic mood disorder characterized by periods of depression that may last weeks to months and periods of mania that may last weeks to months. The key difference between bipolar disorder and major depressive disorder is the presence of a manic episode. You only need one manic episode ever in your life to be diagnosed with bipolar disorder. So what is a manic episode?
Mania is characterized by 7 days of little to no sleep with a feeling of not needing sleep (meaning, it's not that your tired and can't sleep, it's that you feel like you could go without sleep forever), fluctuations in mood, distraction from tasks, grandiosity (thinking you've got special powers or have accomplished great things), flight of ideas (jumping from one idea to the next in a manner that makes sense to you but leaves others confused), risk taking activities (increased sexuality, doing drugs, impulsive spending), pressured speech (speaking so fast others can't interrupt you), and religious preoccupation (thinking God is talking directly to you or becoming more fixated on religion than is your norm). Generally your mood is elevated, but it might be irritable. You might also notice you're switching from happy to angry to elated to crying without understanding the triggers. You need to have at least three of these symptoms if your mood is elevated (four if your mood is irritable), and it needs to last for seven days or be so severe you get hospitalized.
After a manic episode people may fall into a depressive episode or they may be "euthymic," meaning stable in mood. They might go from manic to euthymic to depressed. Generally, there is a distinct period of time between the manic episodes, and when we talk about "rapid cycling," we're thinking about 4 manic episodes in a year. Some people only have one manic episode ever, and then a lifetime of difficult to treat depression. Others have multiple manic episodes. An episode of mania could cause a person to ruin relationships, have health risks, bankruptcy, or serious injury from risky behaviors. People don't always recognize they've had a manic episode.
There are two types of bipolar disorder, type I and type II. Type II is characterized by "hypomania," or a lower intensity mania. If the mania lasts less than 4 days, or isn't so severe that you are impacted by it, we call that type II. There's an important reason for the distinction, as we'll discuss below. Mania cannot be caused by an underlying health condition or by substance use. Substance use can look like mania, but if you take it away, the person may no longer have manic episodes.
Bipolar disorder is a serious medical condition. It can be very difficult to treat. People with bipolar disorder do not generally respond well to antidepressants, making their depression difficult to get under control. Type II bipolar disorder may be able to tolerate specific antidepressants, but generally someone with Type I will do poorly on them. The medications we use for bipolar disorder (mood stabilizers) can be life saving, but also have side effects that need to be monitored. It is also sometimes difficult for a person experiencing mania to recognize they have a problem, and they might stop taking their medication.
Many people who say they think they have bipolar disorder may actually have mood dysregulation caused by other factors. The term "mania" has become so mainstream, people don't often know what it actually entails. Lots of people have mood dysregulation. Many of us fluctuate from happy to sad to angry when we're really stressed out. A lot of people have not learned how to control or manage their moods, making them feel out of control. However, that doesn't mean you have bipolar disorder.
If you're interested in learning more about living with bipolar disorder, we recommend reading "An Unquiet Mind" by Dr. Kay Redfield Jamison. If you are having mood symptoms that you don't know how to manage, contact us at Saha Psychiatry to set up an appointment!