Bipolar disorder — known as manic depression 30 years ago — is a serious mental illness that is characterized by extreme mood swings, abrupt changes in energy levels, and distorted decision making. In most cases, it develops in the late teens or early adulthood, and is estimated to affect about 5.7 million Americans (approximately 2.6 percent of the population). Bipolar disorder doesn’t discriminate. It affects men and women at virtually equal rates, and the disorder is found among patients of all races, social classes, and ethnic groups.
Mania vs. Depression
Bipolar disorder is typically split into two alternating psychological phases: mania and depression — hence the term “manic depression.” Each phase generally lasts several weeks or more.
The mania phase of bipolar disorder is characterized by excessively energetic moods, restlessness, recklessness, and euphoria. During this time, it’s common to engage in risky behaviors like impulsive sex, compulsive gambling, or lavish spending. The patient feels like he is on top of the world, as if nothing can hurt him. People with bipolar disorder feel most creative during manic phases. If the energy remains relatively low (called a hypomania), a manic phase can lead to a burst of positive productivity.
Mania isn’t always a positive feeling, though. Only about 30 percent of manias feel good or euphoric, and the high energy can quickly turn to irritation, confusion, or excessive anger. The almost-compulsive need to take risks can lead to relationship problems, job difficulties, and, in some cases, problems with the law.
The depressive phase of bipolar disorder is the opposite. The patient feels uncharacteristically sad, anxious, and racked by guilt. Low energy leads to excessive time in bed and increased sleep. People have little or no interest in hobbies, friends, or daily activities. Depression occurs more often than mania, to the point that it requires only one episode of mania to get a bipolar disorder diagnosis. Most of the episodes and impairments come from the depressed side of the condition.
In rare cases, some patients cycle through their moods much faster than other patients with bipolar disorder, a phenomenon known as “rapid cycling.” Rapid cyclers can flip between the two moods in less than a week — or, in extreme cases, several times in a single day. These mood shifts are independent of outside events, and, thus, confusing to family, friends, and coworkers.
Doctors call bipolar disorder a “kindling” illness — meaning that it gets progressively worse. Without treatment, episodes are longer and more impairing, and the time between episodes is shorter. This is why physicians strongly encourage people to stay on their medications, even when they feel well. It is vital, in the long run, to prevent episodes rather than treat them.
Bipolar I vs. Bipolar II
Bipolar disorder has several subtypes, but the most common are Bipolar I and Bipolar II. Bipolar I is much more serious. It is characterized by intense depression and manias that, in some cases, require hospitalization if left untreated. With Bipolar II, the patient experiences a constant, low-grade depression with occasional milder episodes of mania, called hypomania. Hypomania causes moderate euphoria and increased productivity. In some cases, the patient may not even realize that he is acting abnormally. Bipolar II patients are often misdiagnosed with depression, since this is the symptom they feel most of the time.
Bipolar disorder often runs in families, so if one or more of the patient’s close relatives has been diagnosed, there is an increased chance that he will be diagnosed with it. However, bipolar is often misdiagnosed due to the lack of an overt manic episode.
The average time from onset of symptoms (17.7 years of age) to the first recognition and treatment of symptoms (27 years of age, on average) is often a decade of being depressed and impaired without treatment. Untreated bipolar disorder is serious. Some experts estimate that up to 30 percent of people with untreated bipolar disorder eventually commit suicide.
The good news: Most cases of bipolar disorder are treatable and manageable. Treatments include medication, cognitive behavioral therapy, psychotherapy, and, when medications do not achieve control of the episode, electroconvulsive therapy. The first step in effectively treating bipolar is an accurate diagnosis.
With proper support, bipolar people can function normally and live fulfilling lives.
Read how to get an accurate bipolar diagnosis here.