Bipolar disorder, also known as manic-depression, is a mood disorder in which one fluctuates between episodes severe depression and mania. These episodes are often separated by periods of being well. If left untreated, the frequency and severity or both manic and depressive episodes may increase.

Bipolar Disorder

The main symptom of a manic episode is an extremely elevated mood, although sometimes extreme irritability occurs instead. Other symptoms are extremely high energy, inflated self-esteem, risky or erratic behavior, racing thoughts, rapid talking. One may appear to be high on street drugs. In some people there are psychotic symptoms during a severe manic or depressive episode.

There is much variation in the length of a manic or depressive episode, but a manic episode typically lasts for 4 months and a depressive episode for 6 months. Some people have more depressive episodes than manic episodes, or vice versa. Mixed states also can occur. A mixed episode is when symptoms of both mania and depression occur simultaneously, e.g. depressed mood with high energy. When there are four or more episodes a year, it is called rapid cycling.

Diagnosing a Manic Episode: The symptoms must be present for at least one week and there must be at least three symptoms in addition to mood disturbance - and the mood disturbance must cause marked impairment in daily functioning.

Symptoms of a Manic Episode:
Mood disturbance: either euphoric mood or extreme irritability or anger
High energy
Feeling overly confident or inflated self-esteem (grandiosity) or paranoia
No need or decreased need for sleep
Racing thoughts, talking very fast
Poor judgment resulting in inappropriate or risky behavior - gambling, overspending, unprotected sex, abusing drugs / alcohol
Easily distracted

Bipolar disorder is treated with both mood stabilizers and antidepressants. Mood stabilizers are taken even when one is feeling well to prevent future mood swings, as bipolar disorder is almost always a recurrent illness. Though Mood stabilizers are effective in reducing the incidence of depression and mania, there may still be breakthrough episodes. Antidepressants are added to treatment during an episode of depression. Antidepressant medications taken alone, without a mood stabilizer, can trigger an episode of mania.

Some people have a milder version of bipolar disorder (bipolar disorder II) where depression alternatives with hypomania rather than severe mania. Hypomania is a mild form of mania. There is never any psychosis. The person may feel mildly euphoric or irritable and has other mild symptoms of mania. Hypomania can feel quite pleasant (unless it presents as irritability) and one may wonder if there is any reason for treatment. However, hypomania is sometimes an early symptom of bipolar disorder and may develop into full-blown mania if left untreated.

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