*The information below is purely for educational purposes and not to be used as guidance for diagnosis or treatment of any condition. Consult with a trusted healthcare provider prior to making any decisions related to your healthcare.*
Bipolar Disorder is a widely misunderstood and commonly misdiagnosed condition. For years, “bipolar” has been used as an adjective to describe quickly changing states such as inconsistent weather patterns (e.g., “this spring has been so bipolar”), or rapidly shifting moods (e.g., “he’s been so bipolar lately”). “Manic” is another common adjective used to describe erratic or impulsive behavior. The flippant nature of this language and common misrepresentations of this condition in media can lead to inappropriate use of these phrases, contributing to the lack of understanding and stigma surrounding bipolar disorder.
Bipolar Disorder is a chronic, cycling mood disorder that has different clinical features associated with it depending on what phase or cycle of the illness someone is currently experiencing. “Bipolar” or “two poles” refers to the opposite extreme mood states present in the illness including depression and mania (or hypomania). To meet criteria for Bipolar Disorder, an individual needs to have experienced at least 1 major depressive episode AND at least 1 episode of either hypomania or mania in their lifetime. Bipolar Disorder is generally treated using medications (primarily mood stabilizers), therapy, and other lifestyle modifications.
A diagnosis of Bipolar 1 Disorder is given if someone experiences depressive and manic episodes, and a diagnosis of Bipolar 2 Disorder is given if someone experiences depressive and hypomanic episodes. Read more below to learn about the differences between depressive, hypomanic, and manic episodes.
Depressive Episode
To meet criteria for a major depressive episode, an individual must experience a total of 5 of the following symptoms, lasting for at least 2 weeks:
- Either depressed mood (e.g., sad, empty, blue) OR markedly decreased interest or pleasure in activities (1 of these is required),
- Significant weight gain/loss or change in appetite,
- Sleep disturbance (troubles sleeping or sleeping too much),
- Changes in physical movement (increased restlessness or very slow movements),
- Significant fatigue or lower energy,
- Feelings of hopelessness, worthlessness, or excessive guilt,
- Worsening issues with concentration or decision making
- Recurrent thoughts of death/dying, or suicidal ideation.
Depression is more commonly identified due to higher rates of depression across the population, increased awareness and acceptance surrounding depression, and the tendency for individuals to reach out or seek help when they’re feeling depressed. Episodes of depression can last anywhere from 2 weeks, up to months or even years at a time without adequate treatment or support. People who have Major Depressive Disorder may experience recurrent episodes of depression with a return to normal baseline functioning in between episodes of depression, with no presence of hypomanic or manic episodes during their lifetime. Major Depressive Disorder is generally treated using medications (antidepressants such as SSRIs/SNRIs/etc.), therapy, and other lifestyle modifications.
Hypomanic Episode
To meet criteria for a hypomanic episode, an individual must experience a distinct period of the following symptoms, lasting for at least 4 days in a row, for most of the day, nearly every day during the 4+ day period:
- Abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased activity or energy (these are required), AND
- 3+ of the following symptoms during this same period of time (4+ if mood is only irritable but not elevated/expansive)
- Significantly increased self-esteem or “grandiosity” (feeling of excessive superiority/uniqueness/invulnerability),
- Decreased need for sleep (i.e., feeling energized after only a few hours of sleep),
- Increased talkativeness or drive to keep talking,
- Racing thoughts that may be unrelated or difficult for others to follow,
- Increased distractibility (i.e., attention drawn very easily to unimportant or irrelevant things),
- Increased goal-directed activity (e.g., significant increased productivity at work/school/home or much higher sex drive),
- Excessive involvement in activities with a high potential for harmful consequences (e.g., unrestrained buying sprees, increased sexual impulsivity/promiscuity, extremely risky business decisions, increased substance use, reckless driving).
When someone experiences a hypomanic episode, it may impair their functioning to some degree but often it is not severe enough to cause significant impairments at home or work, and symptoms are not severe enough to warrant hospitalization. Hypomanic episodes may often go unrecognized because people may perceive that they “just feel really good” or find that they are being very productive, which is generally not viewed as being a problem, and individuals don’t commonly seek out psychiatric care during a hypomanic episode. You might wonder what the issue is with someone experiencing hypomanic episodes- unfortunately, unmanaged bipolar disorder can have negative effects on brain health and actually worsen the course of the illness over time.
Manic Episode
To meet criteria for a manic episode, an individual has to experience the same symptoms as a hypomanic episode as described above, but the symptoms must last for at least 1 week and the symptoms are severe enough to cause significant impairment in someone’s functioning at work or at home. Manic episodes are often severe enough that they may result in psychiatric hospitalization, significant consequences leading to law enforcement involvement, or can even result in death due to the risks associated with the impulsivity that may accompany a manic episode. Manic episodes may include symptoms of psychosis such as auditory or visual hallucinations, delusional thinking, or paranoia.
*It’s important to note that in order to meet criteria for any of the episodes above, symptoms cannot be due to the use of a mind-altering substance that induces or creates the associated symptoms of that mood state. For example, a depressive episode due to abuse of “downers” like alcohol or sedatives, or a hypomanic/manic episode due to abuse of “uppers” or stimulating drugs/substances would be characterized as a substance-induced mood disorder as opposed to a true mood disorder. A depressive/hypomanic/manic episode that happens in the context of sobriety (and no medical contributors) is generally seen as a true episode meeting criteria for diagnosis.*
The symptoms of Bipolar Disorder can look very similar to that of other mental health conditions including Borderline Personality Disorder, Post-Traumatic Stress Disorder, Attention-Deficit Hyperactivity Disorder, and more. These conditions are all treated using different approaches, so it’s important that folks are identified and treated appropriately.
If you or a loved one have previously been diagnosed with Bipolar Disorder or are questioning whether you may have Bipolar Disorder, we at Calming Currents Psychiatry are skilled in differentiating the symptoms of Bipolar Disorder from other similar looking disorders and are equipped to help manage and treat Bipolar Disorder and similarly presenting conditions utilizing evidence-based practice guidelines.