Symptoms and Complications
Bipolar disorder is a condition in which the person's mood changes in cycles over weeks to months. The nature of mood changes vary from one person to the next. There are four different kinds of mood states or "episodes" in bipolar disorder and these are described in further detail below: mania, hypomania, depression, and mixed episodes involving symptoms of mania and depression. Over the course of the disorder, a person may go through periods of elevated mood, depressed mood, and times when mood is normal.
Mania often begins with a pleasurable sense of heightened energy, creativity, and social ease. However, these feelings quickly progress to full-blown euphoria (extremely elevated mood) or severe irritability. During a manic episode, the person will also have at least four of the following symptoms for at least one week:
- needing little sleep
- talking so fast that others cannot follow you
- having racing thoughts
- having hyperactivity or agitation
- being so easily distracted that your attention shifts between many topics in just a few minutes
- having an inflated feeling of power, greatness, or importance
- doing reckless things without concern about possible consequences (e.g., spending too much money, engaging in inappropriate sexual activity, or making risky business investments)
Hypomania is a milder form of mania that has similar but less severe symptoms and has less negative impact on a person's daily activities. During a hypomanic episode, the person may have an elevated mood and be more productive. Because these episodes often feel good, the quest for hypomania may even cause some people with bipolar disorder to stop taking their medications. However, a person does not usually stay in a hypomanic episode for long and gradually shifts into either mania or depression.
Depression: During a depressive episode, the person experiences feelings of sadness or loses interest in the things one normally enjoys. At least four of the following additional symptoms persist for at least two weeks:
- insomnia (trouble sleeping) or sleeping too much
- loss of appetite or eating too much
- decreased interest in pleasurable activities
- fatigue or loss of interest
- problems concentrating or making decisions
- feeling slowed down or feeling too agitated to sit still
- feeling worthless or guilty or having very low self-esteem
- recurring thoughts of suicide or death
Mixed episodes: The most disabling episodes are those that involve symptoms of both mania and depression together, or alternating frequently during the day. Individuals are excitable or agitated as in mania, but they also feel irritable and depressed. Mixed episodes present the highest risk of suicide. Up to 15% of all people with bipolar disorder may commit suicide.
In severe cases of bipolar disorder, the person may also experience psychotic symptoms which are hallucinations (hearing or seeing things that are not there) or delusions (firmly believing things that are not true).
Patterns of bipolar disorder
People with bipolar disorder vary in the types and frequency of episodes that they experience. Some people may have equal numbers of manic and depressive episodes, while others may have mostly one type or the other. On average, a person has four episodes during the first 10 years of having bipolar disorder.
While several years can pass between the first few episodes, without treatment most people eventually have more frequent episodes. Episodes can last for days, weeks, months, or sometimes even years.
Classifications
According to the episode patterns, bipolar disorder can be classified as:
- Bipolar type 1 - a person has one or more manic episodes, usually accompanied by major depressive episodes.
- Bipolar type 2 - a person has only hypomanic and depressive episodes, not full mania or mixed episodes. Hypomania often seems normal to the person, and they seek treatment only for depression.
- Rapid cycling bipolar disorder - a person has at least four episodes per year in any combination of mania, hypomania, mixed, or depression.