Signs And Symptoms Of Bipolar Disorder
Bipolar disorder involves periods of elevated mood, or mania, alternating with periods of depression. A person with bipolar disorder typically cycles between these two extremes, often with periods of normal mood in between. The pattern of symptoms differs from person. Some people are more prone to either mania or depression, while others experience equal numbers of manic and depressive episodes. The frequency and duration of the mood episodes also varies widely. While a few individuals experience only one or two periods of mood disruption, most people with bipolar disorder suffer from multiple, recurring manic and depressive episodes.
There are four types of mood episodes that can occur in bipolar disorder: (Source: NIMH)
- Mania (Manic Episode)
- Hypomania (Hypomania Episode)
- Depression (Depression Episode)
- Mixed Episode
Mania (Manic Episode)
In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. Cognitive changes in mania include grandiosity and feelings of omnipotence. People with mania also tend to be reckless, impulsive, and quick to anger. They lash out when others do not go along with their plans and blame anyone who dares to criticize their behavior. They also typically lack insight and judgment during a manic episode. Manics rarely seek help because they feel great and don't recognize that anything is wrong.
Signs Of Mania Or A Manic Episode
- Inflated self esteem or grandiosity
Inflated self importance; in some, delusions or hallucinations. Feeling all powerful, invincible, and destined for greatness.
- Euphoric mood
Feeling high, excessively optimistic, better than ever before.
- Extreme irritability
Feeling irritable or angry; Behavior that is aggressive, provocative, or intrusive.
- Decreased need for sleep
Feeling rested after just a few hours of sleep.
- More talkative than usual
Extremely talkative and sociable; pressure to keep talking.
- Racing thoughts
Flight of ideas; can't keep up with your own ideas and thoughts.
Inability to concentrate, distracted, restless.
- Increase in goal-directed activity or psychomotor agitation
Extremely energetic; increased productivity; a feeling of high intelligence and creativity.
- Risky behavior
Excessive involvement in pleasurable or high risk activities, such as sex, drug or alcohol use, gambling, or spending sprees.
- Impaired judgment
Reckless, impulsive, unpredictable; No perception that the mood and behaviors are abnormal.
Hypomania (Hypomanic Episode)
Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but their symptoms are milder than those of mania and cause less impairment to functioning. Unlike manics, people with hypomania never suffer from delusions and hallucinations. They are able to carry on with their day-to-day lives. To others, it may seem as if the hypomanic individual is merely in an unusually good mood. But unfortunately, hypomania often escalates to full-blown mania or is followed by a major depressive episode.
Depression (Major Depressive Episode)
The depressive phase of bipolar disorder is very similar to that of major depression. However, there are some notable differences. When compared to major depression, bipolar depression is more likely to include symptoms of low energy. People with bipolar depression tend to move and speak slowly and sleep a lot. They are also more likely to have psychotic depression, a condition in which they have lost contact with reality. The depressive phase of bipolar disorder is often very severe, with suicide a major risk factor. Hospitalization is sometimes necessary. People are more likely to seek help during the depressive phase of bipolar disorder because the symptoms are unpleasant and recognizably disruptive. But some do not even seek help during depressive episodes because they have no energy and no hope that anything can change.
Signs Of Depression Or A Depressive Episode
- Depressed mood
Feeling hopeless, sad, discouraged, or empty.
- Loss of interest or pleasure
Inability to experience pleasure. Nothing seems to interest you anymore, including former hobbies, social activities, and sex.
- Appetite or weight changes
Significant weight loss or weight gain a change of more than 5% of body weight in a month.
- Sleep changes
Insomnia or oversleeping (also known as hypersomnia).
- Psychomotor agitation or retardation
Keyed up, unable to sit still, anxious, restless or sluggish, slow speech and body movements, lack of responsiveness.
- Fatigue or loss of energy
Physically drained. Even small tasks are exhausting. Cant do things as quickly as you used to.
- Self loathing
Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes.
- Concentration problems
Inability to focus. Difficulty making decisions. Can't think straight. Memory problems.
Mixed Episode (Major Depression and Mania)
A mixed episode features symptoms of both full-blown mania and depression, either occurring simultaneously or alternating frequently. A mixed episode features the low mood and irritability of depression combined with the agitation of mania. This combination of high energy and depression makes for a particularly high risk of suicide.
Types Of Bipolar Disorder
Bipolar disorder can take several forms, depending upon the severity, pattern, and frequency of the manic and depressive episodes.
- Bipolar I Disorder Mania and Depression
Bipolar I Disorder is the classic manic depressive form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. Although a previous episode of major depression is not required for diagnosis, the vast majority of people with Bipolar I Disorder have experienced one. The typical course of Bipolar I Disorder involves recurring cycles between mania and depression.
- Bipolar II Disorder Hypomania and Depression
In Bipolar II disorder, the person doesnt experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression. In order to be diagnosed with Bipolar II Disorder, you must have experienced at least one hypomanic episode and one major depressive episode in your lifetime. If you ever have a manic episode, your diagnosis would be changed to Bipolar I Disorder.
- Cyclothymia Hypomania and Mild Depression
Cyclothymia, also known as cyclothymic disorder, is a milder form of bipolar disorder. Like bipolar disorder, cyclothymia consists of cyclical mood swings. However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be taken seriously and treated.
- Rapid Cycling Frequent episodes in Bipolar I or Bipolar II Disorder
Rapid cycling is a subtype of bipolar disorder characterized by four or more manic, hypomanic, or depressive episodes within one year. The shifts from low to high can even occur over a matter of days or hours. People with Bipolar I and Bipolar II disorder can experience rapid cycling. According to the National Institute of Mental Health, rapid cycling usually develops later in the course of bipolar disorder. To learn more, read Bipolar Disorder: Rapid Cycling and its Treatment.
Bipolar disorder runs in families, with genetics believed to play a significant role. A person with this inherited vulnerability may develop bipolar disorder in response to environmental triggers such as a traumatic experience or drug abuse.
- Neutrotransmitter Imbalance
Serotonin, dopamine, and norepinephrine are three neurotransmitters or chemical messengers in the brain that help regulate our moods. It is believed that imbalances in these biochemicals are responsible for the mood swings of bipolar disorder.
- Brain Metabolism
Brain imaging scans reveal significant differences between the metabolism of a normal brain and a bipolar brain. During normal mood, brain activity and blood flow across the two sides of the brain are basically equal. But in a manic or depressed state, different areas of the brain are more active than others.
- Hormonal Imbalance
Hormonal imbalances have been found in many people with bipolar disorder. In particular, high levels of the stress hormone cortisol and abnormal levels of thyoid hormone are believed to contribute to manic and depressive mood episodes.
- Biological Rhythyms
Disturbances in circadian rhythms have been implicated in bipolar disorder. Some researchers believe that the biological clock that regulates our sleep-wake cycle is abnormally fast in people with bipolar disorder.
Bipolar Disorder Triggers
Severe stress or emotional trauma can trigger either a depressive episode or a manic episode in an individual predisposed to bipolar disorder. Stress can also prolong a bipolar mood episode.
- Major Life Event
Major life events such as getting married, going away to college, or starting a new job can trigger a mood episode.
- Substance Abuse
While substance abuse doesnt cause bipolar disorder, it can bring on manic or depressive episodes and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
- Medication-Induced Mania
Certain medications, most notably antidepressant drugs, can trigger a manic episode. If antidepressants are prescribed during the depressive phase of bipolar disorder, they must be taken with a mood stabilizer in order to avoid this complication. Other drugs that may induce mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
- Seasonal Changes
Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring. These patterns are believed to be tied to seasonal fluctuations in light.
- Sleep Deprivation
Sleep deprivation even as little as skipping a few hours of sleep can trigger an episode of mania.
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